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Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis. In this condition white blood cells attack multiple joints causing inflammation, which results in joint pain and swelling. If untreated, RA leads to permanent joint damage and disability. Early diagnosis and treatment with synthetic disease-modifying anti-rheumatic drugs (DMARDs) is critical to control inflammation and prevent joint damage: also known as disease remission. However, around 40% of patients with RA do not respond to or cannot tolerate synthetic DMARDs; in these patients a biologic treatment (i.e. anti-TNF) should be started without delay.

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In Crystal Arthropathies, joint inflammation is caused by deposit of crystals in the joints. These crystals can be mainly formed by urate in gout and by calcium pyrophosphate (CPP) in CPP disease (CPPD) or sometime known as “pseudo-gout”. Gout can happen as an acute attack of joint pain and swelling (gout attack) or a persistent inflammation of the joints (chronic gout). The underlying cause is raised uric acid levels in the blood, which may be present for years without acknowledgement. Treatment involves lifestyle changes, tablets to reduce uric acid levels and anti-inflammatories to control joint pain. Differently from gout, no drugs can modify CPP deposition and thus CPPD management is still purely symptomatic with the use of anti-inflammatory drugs and intra-articular or parental corticosteroid.

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Ankylosing spondylitis (AS) is a progressive, disabling inflammatory condition that affects mainly the spine (spondylitis meaning spine inflammation). This condition causes severe low back and neck pain, typically at night time. If untreated, AS reduces the flexibility of the spine leading to profound disability. Thus, early diagnosis (i.e. with an MRI scan) and treatment are critical to prevent disease evolution.

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Psoriatic arthritis is a form of chronic joint inflammation associated with a skin condition called psoriasis (a red, scaly skin rash frequently affecting elbows, knees, scalp and fingernails). The arthritis can develop before the psoriasis, without psoriasis or in patients with a close relative affected by psoriasis. Symptoms of psoriatic arthritis can be diverse and include stiff, swollen and painful joints with sausage-like swelling of fingers or toes, involvement of the spine with low back pain and pain in the tendons (i.e Achilles tendons).

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Systemic Lupus Erythematosus (SLE or Lupus) is a potentially severe autoimmune disease in which the immune system produces antibodies that attack the body's tissues, causing inflammation and damage. Lupus normally develops in women and can affect virtually any part of the body but more frequently the skin (rashes after sun exposure), the joints (pain and swelling) and several internal organs including the kidneys, the heart and the lungs. Other common symptoms include extreme tiredness (fatigue), fever, and weight loss, swelling of the lymph glands, hair loss and mouth ulcers. Effective treatments are available for lupus; these depend on the involved organs and the severity of the disease.

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Sjogren’s syndrome (SS) is the second most common rheumatic autoimmune disease and mainly affects women (9:1 female to male ratio). It is often underdiagnosed or diagnosed with long delays. SS causes inflammation of several glands in the body resulting in dry mouth, dry eyes, dry throat, dry skin and vaginal dryness. Other symptoms typically include severe fatigue, multiple joint and muscle pain and peripheral neuropathy (i.e. pins & needles with burning pain in arms and legs). In some patients, other complications can occur including involvement of kidneys, lungs and lymphoma.

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Raynaud’s phenomenon causes the blood supply to fingers or toes to be reduced in cold or emotionally stressful conditions, which results in discomfort and the affected areas changing colour. These colour changes are often accompanied by pain or a tingling feeling. It is important that patients with Raynaud’s are assessed by a Rheumatologist in order to exclude the presence of an underlying connective tissue disease such as lupus, scleroderma or Sjogren’s syndrome.

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Vasculitis means inflammation of the blood vessels due to activation of the immune system. It can cause a variety of different problems and severe complications starting with general feeling unwell, fever, sweats, fatigue and weight loss. Other symptoms vary according to which part of the body is affected, for example: skin ulcers, nosebleeds, red or painful eyes, pins and needles or weakness in the arms and legs, joint pain or swelling, muscle aches, coughing and shortness of breath, strokes, problems passing urine or blood in the urine. Headaches, pain in the jaw and problems with the eyes can also be serious symptoms.

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Polymyositis and dermatomyositis are rare but potentially severe autoimmune conditions in which the immune system attacks the body's muscles (myositis meaning muscle inflammation). Typical symptoms include muscle weakness in arms and legs and generally feeling unwell. In dermatomyositis also the skin is affected causing a rash (often on the chest and hands) and swelling around the eyes. The diagnosis is made using a combination of blood tests, imaging (i.e. muscle MRI) and electromyography followed by a muscle biopsy of the affected area. The disease requires immediate treatment with appropriate drugs.

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Osteoarthritis is a condition that affects the surfaces of the joints and is also known as “wear and tear”. In osteoarthritis, the cartilage which forms a cushion between bone ends in the joints gradually thins, and the bone underneath thickens. In severe osteoarthritis, the bones rub against each other causing pain (i.e. knee pain when climbing up and down stairs). Progressively, this process can severely damage the joint, causing disability.

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Back pain is a common problem which affects up to 80% of the general population. It can be caused by a simple muscle, tendon or ligament strain or by a more serious problem. Often back pain is due to a range of factors, including: poor posture, lack of exercise resulting in stiffening of the spine, muscle strains or sprains. There are also specific conditions which are associated with pain felt in the back like spondylosis, sciatica or spinal stenosis. A specialist Rheumatology consultation can help in distinguishing the underlying cause and guide appropriate treatment.

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Carpal tunnel syndrome is a condition in which the median nerve is compressed inside the wrist tissues and this can cause pain or aching, tingling or numbness in the affected hand. Women are more affected than men and hormonal changes can play a significant role.

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Long Covid is a severe condition that causes fatigue, cognitive issues, breathing disorders, dysautonomia and PoTs. Clinical Trials have shown how certain monoclonal antibodies  may be capable of reversing severe long COVID. Beyond providing an effective potential treatment for long COVID, these findings have mechanistic implications for treating other post-viral chronic conditions, including future long COVID variants.

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